Healthcare Systems & Services Practice

When will the COVID-19

pandemic end?
Normalcy by spring, and herd immunity by fall? We assess the
prospects for an end in 2021.

This article was a collaborative effort by Sarun Charumilind, Matt Craven, Jessica Lamb,
Adam Sabow, and Matt Wilson.

© Svetikd/Getty Images

September 2020
 In 1920, a world wearied by the First World War and
sickened by the 1918 flu pandemic desperately sought
to move past the struggles and tragedies and start
to rebuild lives. People were in search of a “return to
normalcy,” as Warren G. Harding put it. Today, nearly
every country finds itself in a similar position.
The two ends are related, of course, but not linearly.
At the latest, the transition to normal will come
when herd immunity is reached. But in regions with
strong public-health responses, normalcy can likely
come significantly before the epidemiological end of
the pandemic.

More than eight months and 900,000 deaths
into the COVID-19 pandemic,1 people around the
world are longing for an end. In our view, there are
two important definitions of “end,” each with a
separate timeline:
— An epidemiological end point when herd
immunity is achieved. One end point will occur
when the proportion of society immune to
COVID-19 is sufficient to prevent widespread,
ongoing transmission. Many countries are
hoping that a vaccine will do the bulk of the work
needed to achieve herd immunity. When this end
point is reached, the public-health-emergency
interventions deployed in 2020 will no longer
be needed. While regular revaccinations may be
needed, perhaps similar to annual flu shots, the
threat of widespread transmission will be gone.
— A transition to a form of normalcy. A second
(and likely, earlier) end point will occur when
almost all aspects of social and economic life
can resume without fear of ongoing mortality
(when a mortality rate is no longer higher than a
country’s historical average) or long-term health
consequences related to COVID-19. The process
will be enabled by tools such as vaccination of
the highest-risk populations; rapid, accurate
testing; improved therapeutics; and continued
strengthening of public-health responses. The
next normal won’t look exactly like the old—it
might be different in surprising ways, with
unexpected contours, and getting there will be
gradual—but the transition will enable many
familiar scenes, such as air travel, bustling shops,
humming factories, full restaurants, and gyms
operating at capacity, to resume.
The timeline to achieve the ends will vary by location.
In this article, we’ll explain the criteria that will be key
factors in determining when each is reached. In the
United States and most other developed economies,
the epidemiological end point is most likely to be
achieved in the third or fourth quarter of 2021,
with the potential to transition to normalcy sooner,
possibly in the first or second quarter of 2021. Every
day matters. Beyond the impatience that most feel
to resume normal life, the longer it takes to remove
the constraints on our economies, the greater will be
the economic damage.
The epidemiological end point
Most countries have deferred the hope of achieving
herd immunity until the arrival of a vaccine. When
herd immunity is reached, ongoing public-health
interventions for COVID-19 can stop without fear of
resurgence. The timing of the end point will vary by
country and will be affected by a number of factors:
— the arrival, efficacy, and adoption of COVID-19
vaccines—the biggest drivers in the timeline to
herd immunity2
— the level of natural immunity in a population from
exposure to COVID-19; in our estimate, between
90 million and 300 million people globally may
have natural immunity3
— potential cross-immunity from exposure to other
coronaviruses4
— potential partial immunity conferred by other
immunizations, such as the bacille Calmette–
Guérin (BCG) vaccine for tuberculosis5

1
Coronavirus Resource Center, Johns Hopkins University & Medicine, September 18, 2020, coronavirus.jhu.edu.
2
Virus-neutralizing antibodies could also confer immunity but are less likely to be deployed at sufficient scale to achieve herd immunity in
large populations.
3
For calculation and sources, see sidebar, “Key factors affecting the timeline to herd immunity.”
4
Jose Mateus et al., “Selective and cross-reactive SARS-CoV-2 T cell epitopes in unexposed humans,” Science, August 4, 2020, science.
sciencemag.org.
5
Martha K. Berg et al., “Mandated Bacillus Calmette-Guérin (BCG) vaccination predicts flattened curves for the spread of COVID-19,”
Science Advances, August 2020, Volume 6, Number 32, advances.sciencemag.org.

2 When will the COVID-19 pandemic end?

 — regional differences in the ways that people
mix, which will produce different thresholds for
herd immunity
Consider the first and most crucial variables:
the arrival of vaccines, their efficacy, and their
adoption. We see four plausible scenarios for
vaccine efficacy and adoption, illustrated in
Exhibit 1.6 Different combinations of those two
factors will drive varying levels of conferred
immunity, implying the extent of natural immunity
that will be required to reach herd immunity under
each scenario. Combinations of efficacy and
adoption beyond those shown are possible.
The other variables will also have much to say about
the timeline to reach herd immunity (see sidebar,
“Key factors affecting the timeline to herd immunity”).

Web <2020>
Exhibit 1
<COVID-Automation>
Exhibit <1> of <3>
Vaccine efficacy
Vaccine efficacy and
and coverage
coverage are
are both
both important;
important; vaccination
vaccination alone
alone may
may not
achieve herd immunity.
not achieve herd immunity.
COVID-19-immunity scenarios¹

100
Herd immunity
achieved through
vaccine alone
80 1 Natural-immunity
level required for
herd immunity, %
3
60
Vaccine
efficacy,
%
4 2 10
40 20
30
20
45
0
0 20 40 60 80 100

Vaccine coverage, %

1 Optimistic 2 High coverage 3 Midpoint 4 Pessimistic

Efficacy is close to that of
common childhood
vaccinations; coverage is
close to 70% (share of survey
respondents willing to receive
a vaccine ≤3 months after it
is available)
Efficacy meets minimum
threshold for approval;
coverage is close to that
of common childhood
immunizations
Efficacy is above
minimum threshold for
approval but less than
that of common childhood
vaccinations; coverage is
similar to that of flu
vaccines
Efficacy meets minimum
threshold for approval;
public hesitance to adopt
vaccine similar to healthy
adults’ adoption of flu
vaccines, with relatively
low coverage ceilings

¹COVID-19 herd immunity achieved once total immune population reaches 58%, using basic reproductive number (R0) of 2.4; herd-immunity threshold calculated
as 1 – (1/R0).
Source: US Food and Drug Administration; McKinsey COVID-19 Survey, July 17, 2020

6
Exhibit 1 assumes a basic reproductive number (R0) of 2.4 and uses a standard formula to arrive at an estimated herd-immunity threshold of
58 percent.

When will the COVID-19 pandemic end? 3

 Key factors affecting the timeline to herd immunity

Apart from vaccines, several other factors
will shape the path to achieving COVID-19
herd immunity in a given population.
Natural immunity to SARS-CoV-2
Globally, of the approximately 30 million
people known to have COVID-19, more than
900,000 have died.1 The rest have recov-
ered and have some degree of natural im-
munity to SARS-CoV-2 (the novel coronavi-
rus), the virus that causes the disease. While
there has been at least a few documented
cases of reinfection, most experts expect
that the majority of those exposed to the
virus are immune for some period of time.
It’s likely that many more infections haven’t
been detected. Estimated case-detection
rates range from 3:1 to 10:1.2 That would
mean that between around 90 million and
300 million people around the world have
some immunity to SARS-CoV-2.
Infection rates vary widely. In some places,
such as Mumbai and New York City, sub-
population antibody-positivity rates range
up to 50 percent.3 But those are likely to
be outliers: in most countries, less than
10 percent (and often less than 5 percent)
of populations test positive for antibodies.4
T-cell cross-reactivity to
other coronaviruses
Some recent studies suggest that a
significant number of people who haven’t
contracted COVID-19 have cross-reactiv-
ity in specific immune cells (T cells). Most
of them gained it from contracting other
coronaviruses, which primed their immune
systems to react to COVID-19.5 The degree
to which T-cell cross-reactivity actually
immunizes individuals hasn’t been proven.
If T-cell cross-reactivity provides mean-
ingful immunity, it would offer significant
progress toward herd immunity. The preva-
lence of cross-reactive immunity may vary
substantially by region.
Partial immunity because of
other immunizations
Studies have shown that countries that
require bacille Calmette–Guérin (BCG)
vaccinations for tuberculosis correlate with
lower rates of COVID-19 infections and
related deaths, normalizing for certain key
factors (such as epidemic stage, develop-
ment, rurality, population density, and age
structure).6 Causation hasn’t been proven.
Threshold for achieving herd immunity
The threshold for achieving herd immunity for
COVID-19 is the percentage of a population
that needs to develop immunity to disease
to prevent sustained future transmission.
Once the threshold is reached, the whole
population is protected. A basic formula for
estimating that threshold is one minus the
reciprocal of the basic reproductive number.7
In practice, a herd-immunity threshold is
complicated and varies by setting. The for-
mula relies on several broad assumptions.
One is that each member of a population
mixes randomly with all other population
members. In reality, people mix mostly with
others whose patterns of interaction are
similar to their own. Subpopulations with
fewer interactions have lower thresholds
for herd immunity than do those with more
interactions. An estimated overall thresh-
old for herd immunity can be lower than it
would be if it took into account that sub-
populations with fewer interactions might
drive down an overall threshold, and that
subpopulations with more interactions have
disproportionately already been infected.8
Several epidemiologists who are building
dynamic models of COVID-19 that incorpo-
rate the heterogeneity of population mixing
are predicting lower thresholds for herd
immunity than previously thought. Many
models predict thresholds of about 40 to 50
percent. Other epidemiologists have called
into question those hopeful estimates and
note that policy should be based on conser-
vative estimates of herd-immunity thresh-
olds until better information is available.9

1
Coronavirus Resource Center, Johns Hopkins University & Medicine, September 18, 2020, coronavirus.jhu.edu.
2
Charlie Giattino, “How epidemiological models of COVID-19 help us estimate the true number of infections,” Our World in Data, August 24, 2020, ourworldindata.org;
Hazhir Rahmandad, John Sterman, and Tse Yang Lim, “Estimating COVID-19 under-reporting across 86 nations: Implications for projections and control,” medRxiv,
August 3, 2020, medrxiv.org.
3
Not all serosurveys have used random-sampling methodologies.
4
“COVID-19: Data,” NYC Health, September 21, 2020, nyc.gov. Summary statistics, SeroTracker, September 16, 2020, serotracker.com.
5
Nina Le Bert et al., “SARS-CoV-2-specific T cell immunity in cases of COVID-19 and SARS, and uninfected controls,” Nature, August 20, 2020, Volume 584,
pp. 457–62, nature.com.
6
Martha K. Berg et al., “Mandated Bacillus Calmette-Guérin (BCG) vaccination predicts flattened curves for the spread of COVID-19,” Science Advances, August 2020,
Volume 6, Number 32, advances.sciencemag.org.
7
The basic reproductive number (R0) is a measure of contagiousness or transmissibility. For COVID-19, it can be generally thought of as the expected number of cases
directly generated by a single case in a population in which all people are susceptible. The R0 value for COVID-19 is under debate, with estimates ranging from two to
four. For an example of a low-end estimate, see Max Fisher, “R0, the messy metric that may soon shape our lives, explained,” New York Times, April 23, 2020,
nytimes.com. For an example of a high-end estimate, see Seth Flaxman et al., “Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe,”
Nature, August 13, 2020, Volume 584, pp. 257–61, nature.com.
8
Frank Ball, Tom Britton, and Pieter Trapman, “A mathematical model reveals the influence of population heterogeneity on herd immunity to SARS-CoV-2,” Science,
August 14, 2020, Volume 369, Number 6,505, pp. 846–9, science.sciencemag.org.
9
Abstractions Blog, “The tricky math of herd immunity for COVID-19,” blog entry by Kevin Hartnett, June 30, 2020, quantamagazine.org; Apoorva Mandavilli, “What if
‘herd immunity’ is closer than scientists thought?,” New York Times, August 17, 2020, nytimes.com.

4 When will the COVID-19 pandemic end?

 Based on our reading of the current state of the
variables and their likely progress in the coming
months, we estimate that the most likely time for the
United States to achieve herd immunity is the third
or fourth quarter of 2021. As we wrote in July 2020,
one or more vaccines may receive US Food and
Drug Administration Emergency Use Authorization
before the end of 2020 (or early in 2021) and the
granting of a Biologics License Application (also
known as approval) during the first quarter of 2021.
Vaccine distribution to a sufficient portion of a
population to induce herd immunity could take
place in as few as six months. That will call for
rapid availability of hundreds of millions of doses,
functioning vaccine supply chains, and peoples’
willingness to be vaccinated during the first half
of 2021. We believe that those are all reasonable
expectations, based on public statements from
vaccine manufacturers and the results of surveys on
consumer sentiment about vaccines.7
Herd immunity could be reached as soon as the
second quarter of 2021 if vaccines are highly
effective and launched smoothly or if significant
cross-immunity is discovered in a population
(Exhibit 2). (For more on the potential for a faster
resolution of the COVID-19 crisis in the United States,
see “Searching for optimism in the US response to
COVID-19,” forthcoming on McKinsey.com.) On the
other hand, the epidemiological end of the pandemic
might not be reached until 2022 or later if the early
vaccine candidates have efficacy or safety issues—
or if their distribution and adoption are slow. At
worst, we see a long-tail possibility that the United
States could be still battling COVID-19 into 2023
and beyond if a constellation of factors (such as low
efficacy of vaccines and a short duration of natural
immunity) align against us.

Web <2020>
Exhibit 2
<COVID-Automation>
Exhibit <2> of <3>
The probability
The probabilityofofreaching
reachingCOVID-19
COVID-19herd
herdimmunity
immunityinin theUnited
the United Statesisis
States
highest in the third
third or
orfourth
fourthquarter
quarterof
of2021
2021 but
but could
could shift.
shift.

Probability of functional end¹ to COVID-19 pandemic in US by quarter (illustrative)

Early (Q2 2021) Most likely (Q3/Q4 2021) Late (2022 or later)

2021 2022 2023 2021 2022 2023 2021 2022 2023

COVID-19 vaccine with high efficacy ≥1 COVID-19 vaccine is Early COVID-19-vaccine

arrives sooner than expected authorized by end of 2020 candidates have low efficacy
or early 2021 or low coverage (eg, side effects
Timeline of manufacturing, slow adoption)
distribution, and administration of COVID-19 vaccine is
COVID-19 vaccine is shorter than distributed to a sufficient Timeline of manufacturing,
expected portion of population in distribution, and administration
~6 months of COVID-19 vaccine is longer
Cross-immunity from other than expected
coronaviruses proves significant There is broad-based
willingness to be vaccinated Immunity duration is very short
There is broad-based willingness to
be vaccinated

¹Timeline to functional end is likely to vary somewhat based on geography.

Source: Expert interviews; press search; McKinsey analysis

7
Joe Myers, “3 in 4 adults around the world say they would get a COVID-19 vaccine,” World Economic Forum, September 1, 2020, weforum.org.

When will the COVID-19 pandemic end? 5

 The paths to herd immunity in other high-income
countries are likely to be broadly similar to the one
in the United States. The timelines will vary based
on differences in vaccine access and rollout and
in levels of natural immunity—and potentially, in
levels of cross-immunity and previous coverage
of other vaccines, such as the BCG vaccine. Even
as some locations reach herd immunity, pockets
of endemic COVID-19 disease are likely to remain
around the world, for example in areas affected by
war or in communities with persistently low adoption
of vaccines. In such places, until herd immunity is
reached, COVID-19 might be analogous to measles—
not a day-to-day threat to most people, but a
persistent risk. If immunity wanes—for example, if
booster vaccines are not fully adopted—then COVID-
19 could become more widely endemic.
(such as full lockdowns and restrictions on certain
industries) have significant social and economic
consequences, and others (such as testing and
tracing), while expensive, don’t. Many governments
are employing packages of measures that aim to
minimize the number of COVID-19 cases and excess
mortality while maximizing social and economic
degrees of freedom.
The transition to normal
The second end point of the pandemic may be
reached earlier than the first. We estimate that
the mostly likely time for this to occur is the first
or second quarter of 2021 in the United States
and other advanced economies. The key factor is
diminished mortality.

The arrival of herd immunity won’t mean a complete
end to all public-health interventions. It’s possible
that regular revaccinations would be required to
maintain immunity, and ongoing surveillance for
COVID-19 will be required. But herd immunity would
mean that the emergency measures currently in
place in many countries could be lifted.
The pace at which governments relax public-health
measures will be critical. Some of those measures
Society has grown used to tracking the number
of COVID-19 infections (the case count). But case
counts matter primarily because people are dying
from the disease and because those who survive
it may suffer long-term health consequences
after infection. The latter is an area of scientific
uncertainty, but there is concern that some
recovered patients will face long-term effects.8

Web <2020>
Exhibit 3
<COVID-Automation>
Exhibit <3> of <3>
Reduced COVID-19-related
COVID-19-related mortality
mortality might be achieved
achieved through
through many factors
factors
simultaneously.

Factors that could reduce COVID-19 related mortality

Immunity through Cross- Immunity through Decreased rate Better Natural

COVID-19 vaccine immunity other vaccines of transmission treatment immunity
Rolling out an Potential T-cell Potential Faster identification of Improved under- A larger
effective cross-reactivity correlation COVID-19 and isola- standing of population with
COVID-19 vaccine immunity of between BCG¹ tion measures through COVID-19 and COVID-19
in high-risk SARS-CoV-2 vaccination and rapid, accurate testing advances in its immunity
populations could and other lower COVID-19 could reduce related treatment could through
significantly coronaviruses case counts and mortality and allow significantly de- exposure could
reduce related being related mortality quicker resumption of crease related reduce related
mortality researched being researched activities (eg, air travel) mortality mortality

¹Bacille Calmette–Guérin (BCG) vaccine is widely used as a prevention strategy against tuberculosis.

8
“COVID-19 (coronavirus): Long-term effects,” Mayo Clinic, August 18, 2020, mayoclinic.org.

6 When will the COVID-19 pandemic end?

Most countries have made significant progress in
reducing the numbers of deaths and hospitalizations
associated with COVID-19. Some are close to
eliminating excess mortality. Those results have
generally been achieved through a combination of
moderately effective interventions rather than a
single “big bang” (Exhibit 3).
A transition to the next normal, in whatever form
that takes, will come gradually when people have
confidence that they can do what they used to
do without endangering themselves or others.
Gaining that confidence will require a continuation
of the progress made to reduce mortality and
complications, as well as further scientific study
regarding long-term health consequences for
recovered patients. When confidence is restored,
people will again fill bars, restaurants, theaters, and
sports venues to full capacity; fly overseas (except
for the highest-risk populations); and receive routine
medical care at levels similar to those seen prior to
the pandemic.
The timing of such a transition will depend on the
progress toward herd immunity, as previously
detailed (since more people with immunity means
fewer deaths and long-term health consequences),
and on the effectiveness of a country’s public-health
response. Transitions will be gradual. They have
already begun in some locations and could be well
advanced in most countries by the first or second
quarter of 2021. Given the interconnectedness of the
global economy, country timelines to normalcy are
not fully independent of one another.
To achieve that, we will need to see significant
progress on the epidemiological end point, including
an effective vaccine receiving Emergency Use
Authorization approval during the fourth quarter
of 2020 or the first quarter of 2021, followed
by a smooth rollout and adoption by high-risk
populations. Favorable findings on natural and
Sarun Charumilind and Jessica Lamb are both partners in McKinsey’s Philadelphia office, Matt Craven is a partner in
the Silicon Valley office, Adam Sabow is a senior partner in the Chicago office, and Matt Wilson is a senior partner in the
New York office.
The authors wish to thank Gaurav Agrawal, Xavier Azcue, Jennifer Heller, Anthony Ramirez, Taylor Ray, and Sven Smit for their
contributions to this article.
Designed by McKinsey Global Publishing
Copyright © 2020 McKinsey & Company. All rights reserved.
When will the COVID-19 pandemic end?
cross-immunity would help accelerate timelines.
Five additional criteria will also contribute to the
transition to a form of normalcy—the more of these
that are achieved, the faster the milestone is likely to
be reached:
— continued improvement by governments in the
application of public-health interventions (such
as test and trace) that don’t significantly limit
economic and social activities
— compliance with public-health measures until we
achieve herd immunity
— accurate, widely available, rapid testing that
effectively enables specific activities
— continued advancements in therapeutics
(including pre- and postexposure prophylactics)
for and clinical management of COVID-19,
leading to lower infection-fatality ratios—
substantial progress has already been made
through a combination of effective drugs, such
as dexamethasone and remdesivir, and changes
in clinical management
— public confidence that there aren’t significant
long-term health consequences for those who
recover from COVID-19
Both the epidemiological and normalcy ends to the
COVID-19 pandemic are important. The transition
to the next normal will mark an important social and
economic milestone, and herd immunity will be a
more definitive end to the pandemic. In the United
States, while the transition to normal might be
accomplished sooner, the epidemiological end point
looks most likely to be reached in the second half of
2021. Other advanced economies are probably on
similar timetables.
7